This Isn’t What I Expected. What Comes Next After a Traumatic Birth?

00:00:00 Kara

Hey there, I would love to know what should new moms or expecting moms do when they've experienced trauma before parenthood or their birth was traumatic or past trauma is emerging in their parenting experience and they're coupled with having really scary thoughts and they're not sure if they want to do this again.  They're ambivalent or scared to try to have another baby or they desperately want to.  But the idea of going through this again is so scary.  So really thinking about those moms who have had really significant postpartum mental health conditions and or some sort of trauma, and they're really afraid to have that happen again.  And that might be stopping them from having the family they envisioned.  What can those people do?  What can they explore?  What resources are there?  And what would you say to those parents?  Especially because I kind of am one of those parents.

00:00:59 Dr. Ruta

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions.  I'm Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms.

00:01:12 Allie

And I'm Allie Hales, a mom of four.  I know what it's like to scour the internet wide awake at 2 a.m.  With a million questions, wondering if what I was experiencing was normal.  That's why we created this show.  It isn't just for real moms, it's by real moms.  Pregnancy and delivery can bring incredible joy, but for many, it can also come with unexpected challenges.  This week, we hear from Kara about a topic that hits home for me and so many parents, how to heal after experiencing a traumatic birth and how to make the decision of whether to have another child.  Then I'll speak to some of my own birth experiences, the highs, the lows, what I wish I knew.  First, let's meet Kara, a mom who discovered she would have to have a C-section.  While she felt prepared for that, she wasn't prepared for everything else.  She had issues with pain management during the C-section, and while she came home with a healthy baby, Kara spent the next few months dealing with complications from her surgery.  We hope this episode gives you practical insights and actionable tips, as well as a reminder to be kind and compassionate with yourself as you navigate the unexpected challenges that come with pregnancy and birth.

00:02:23 Kara

I have one child who's now three and a half years old, and I was pregnant during the second half of the COVID pandemic.  And I had a really rough pregnancy.  I actually ended up leaving my full-time job and having to immediately make a career change.  But aside from the pregnancy being challenging, I had a really traumatic birth experience with my son and then ended up having a short NICU stay with him.  And I think had a lot of anxiety even during the pregnancy, just given the nature of the state of the world.  But I think it really compounded after having a traumatic birth and then resulted in a lot of other things that were really challenging for me after and postpartum, for sure.

00:03:03 Dr. Ruta

I was sort of thinking about my clinical experiences and thinking like almost all of my women have had a lot of perinatal trauma, like it's very unusual to have an uncomplicated childbirth experience.  And so when I looked it up, it's about a third of pregnancies are considered to be traumatic.  And I think there's some problems in how we define trauma because it's very subjective.  And the other interesting thing sort of that your story highlights is that there's often a multi-layered aspect of trauma.  So there's just all these multiple layers.  And the other thing that I was thinking about is sometimes the trauma has to do with the medical experience and you're in a very vulnerable place.  People have had a lot of experience with the medical system, but for many, this is their first big interaction.  And I was wondering how that sort of factored into the whole experience.  It's interesting.

00:04:06 Kara

I had a lot of exposure to medical systems just because of my background.  So I had some experience and familiarity and I.  I felt prepared.  I had a scheduled C-section despite not wanting to have to go that route.  And I think that was so important to say, like, you could be the most prepared person in the world and you could know so much and it could still be, to your point, traumatic, even still.  And I think the part that I didn't expect was in the postpartum period, coming home and having medical complications and needing like home care nursing for me.  Like, I never thought that that would ever be a part of the equation of becoming a new mom, that I thought I was going to be taking care of this little human.  Not that I was going to need all of this care myself on top of trying to take care of him.  Right.

00:04:48 Dr. Ruta

I think that your points are very well taken that no matter how much preparation you do, there are unexpected events.  Also, in terms of trauma, people can have traumatic experiences and some people develop post-traumatic stress symptoms.  I wonder if you had any emotional after effects of this whole experience.

00:05:10 Kara

Yeah.  So, I did have postpartum PTSD.  I had a lot of flashbacks.  was extremely like hypervigilant on edge and constantly waiting for something to go wrong all the time.  And I also experienced a lot of dissociation.  I would zone out.  I'm looking out the window.  I'm not really present.  I think being in my body in and of itself was overwhelming for me because it was the site of the trauma, and just having to constantly do incision care.  And then just a general postpartum physical care, I think was a reminder.  And then I also struggled with postpartum OCD that was pretty significant.  And it was primarily health-driven and focused, but sort of a lot of intrusive thoughts about something happening to my son or something happening to me that I was going to die or he was going to die.  And just a lot of checking the baby monitor all the time.  I was checking my own incision like all the time.  There was so much checking around health-related anxiety and just constantly having imagery of something bad happening to him.  So I think that just the combination of the two is so tricky, and it wasn't even picked up that I had this.  I actually was very fortunate that I have friends and family who are in this field and that they picked up on it and said something to me.  It was a ride.  And it took a lot of treatment and a lot of support to get through it.  And I did.  And I no longer have that experience.  But it left a lasting impression on me, which led me to my question for you guys, because there are still those pieces of you that wonder, well, what?  does the future hold and what can I tolerate?  What do I feel like I'm capable of trying to do because of what I know I went through the first time?

00:06:47 Dr. Ruta

We do see that a lot with women who have had traumatic experiences around pregnancy and childbirth and also the postpartum period.  So I do see a lot of women who have had a really severe postpartum depression or postpartum psychosis, and they are often very fearful of going through that experience again.  And I think even like whether it's a medical complication or a psychiatric complication, we can give you a lot of statistics about like how likely this is to happen again.  But I think it's very hard to cross that hurdle.  And I'm wondering.  In terms of some of the medical complications, do you feel you're in a good place with that or is the fear of those complications still with you?

00:07:37 Kara

I think the word you used before is so important.  There's a lot of layers.  It took me a couple of years after having my son and not feeling well just generally to learn that I had an autoimmune disease that probably got activated by some of the trauma experience.  And I've been getting successful treatment around that, but it definitely took.  A couple of years to find some equilibrium.  And I think that in and of itself is very jarring, especially as I'm a working mom and I'm like the primary breadwinner for my family.  So there's like that sense of what's that going to be like if I am not okay.  I am at the point now where medically, like I've had conversations with my OBGYN and endocrinologist and my providers, like my therapist, my psychiatrist to say, hey, like, here's my concerns, you know.  Do we think I can move forward?  And everybody's basically said to me, yeah, like from a medical standpoint, you have a green light; it's really at this point up to you and what you feel works for you, your family, and what you feel like you can handle, and I think that's the tricky part.  Also, just because as time had passed and I started to feel physically well, the demands of parenting my child increased because then I learned he had a disability.  So there was a lot of needs that sort of surfaced that I think layered in.  And there are things that I think other moms definitely ask, you know, what can I handle?  Whether it's the pregnancy, the birth, knowing what postpartum looks like, or just adding to your family and what your child you have needs and how much of you there is to go around, I think is a big stressor for me and something that that's something that like I can't get clearance for necessarily, right?  It's that ambiguity.  That's the tricky part.

00:09:12 Dr. Ruta

In terms of sort of moving forward and being able to make these decisions, what have you found has been the most helpful in terms of treatment or support?

00:09:25 Kara

For my actual treatment and postpartum of doing EMDR therapy and somatic work was instrumental to me really healing the shock.  trauma part of what I went through.  I ended up going back to the hospital a couple of days postpartum, which is where my medical complications started to begin.  And I can recall walking in and smelling like the cleaning smell and just getting really activated.  And now I'm at the point now where I've gone back actually into hospitals and done other work with medical systems.  And I don't experience that anymore.  Like I can sense that my body feels settled and safe.  And so that has been a part where I feel from that standpoint, I could do this again.  I think I could have another baby.  I think peer support has been critical for me.  I absolutely took medication when I was postpartum, and I still do take medication; it has helped me.  And it's something that if you need it, I think is so important that people de-stigmatize that and have access to it.  I think all of that combined was really instrumental.  And at this point, a lot of the things that are helping me, I think trying to make decisions are really also giving myself permission to not have to decide right away.  And also, I acknowledge that with my partner that my husband and I have said, 'it is our decision'.  But ultimately, I am the one who is going to have to experience the greatest shift.  And there has been a lot of conversation, I think, with him and having his support, acknowledging that it's ultimately it's not that it's my decision.  It's our decision, but it's not something that he feels.  I have to decide alone and be; I have to feel responsible for the outcome either way, because the reality is it will affect me far more in the short term and potentially long term than it will affect him if we decide to move forward.  So I think having that grace and space has been instrumental of where I am now compared to where I started in this journey. Right.

00:11:15 Dr. Ruta

I think you also did a really great job of explaining some of the post-traumatic symptoms that one can have.  And there are several different types of therapy that really target that connection between the memories of the experience and this sort of fight or flight flooding reaction.  And I was wondering if you could talk about your experiences with EMDR. Sure.

00:11:39 Kara

The way I will always explain it because of how I experienced it is it's almost like you have these knots in your nervous system, these like blockages, these memories, these experiences that are stuck and they keep you feeling stuck.  And by going back and revisiting them, but doing so where you're in a safe place, you're not reliving it, you're not in an environment where you feel activated, but you have safety with a therapist, you feel heard, and there's an opportunity to take your time, you're able to access revisiting those memories from a different place in your nervous system so that not only can you go back and revisit what happened, and actually emotionally really process it, and actually feel those emotions, and almost metabolize it, your brain is able to access other adaptive pieces of information.  It's really transformative.

00:12:28 Dr. Ruta

I think when it works, it really provides a profound shift in how one experiences these negative events, and in terms of other types of therapy when we're dealing with birth trauma, we want to choose therapies that are specific to dealing with trauma, so certain types of cognitive behavioral therapy also are very effective and help women disconnect the memories from the adverse body responses that one gets.  And I think before someone embarks upon another pregnancy, you want to make sure that you address the trauma, the symptoms associated with the trauma, and also any anxiety or depression that goes along with it, which is exactly what you did.  You checked those boxes off.  When I talk to women about embarking upon another pregnancy after a bad experience, I think you have to set up the supports you might need during the next pregnancy.  I talk about sort of assembling a team of people who are going to help you through the next pregnancy.  And that might be a therapist.  It might be family and friends.  You mentioned peer support.  I think that's tremendously important.  Postpartum Support International has some support groups for women who have had traumatic birth.  They also have peer mentors who can sort of help you through the pregnancy and postpartum period.  Had you thought about how you would like the next pregnancy to go and who will advocate for you?

00:14:06 Kara

Yeah.  So, I actually was very fortunate to have a doula last time.  And it was such a protective piece of things for me, even just like I can see her eyes, even when I think back to my birth experience, just having that grounding image.  And I know that it's something that I would do again for sure in a pregnancy.  And I would also have more postpartum support.  I would probably have a postpartum doula.  I might consider having a night nurse.  And I'm fortunate enough to have the resources to do that.  And those are the things that I would consider, even just having more of a plan with family and friends around what I need and even just in my therapy process planning for that talking it through having a visit set up already with my therapist roughly like in the postpartum period to check in having my psychiatrist tapped into that.  I think all of that would be something I would really want because I sort of tried to piecemeal things together slightly the first time around and also wasn't able to access as much because of the pandemic.  And now, having the ability to see what I experienced, it would be so critical to mitigate the isolation that I couldn't even escape.  But also just now I know what I need.  Like now I know what I would actually really want support with.  And I can be very intentional about planning that the way that I think everybody deserves to have.

00:15:22 Dr. Ruta

You have great communication with your partner.  You have a support network.  You're thinking about the postpartum and getting enough support for yourself.  So, you know, you're really in a place where you've addressed the things that we want women with these experiences to address.  Yet, I think there's often just the uncertainty that people deal with.  And I think yours is also especially more complicated because you've had these experiences, but now.  I think maybe with the autoimmune disorder and putting that into the picture, you're a different person now in many different ways.

00:16:00 Kara

Yeah, for sure.  And I think that it's definitely this internal wrestling around what I want to do.  But I think that it's to your point of uncertainty.  I just have to learn how to, I think, lean into that.  I don't think there's a wrong choice.  I think that there can be grief regardless of in the experience that I'm anticipating, that if I decide to be, I say like one and one, like I won with my one child, if I decide that, that that is enough and that I can grieve that I didn't continue forward for any reason.  And that if I decide to take that risk and navigate that uncertainty, that I ensure that I'm allowed to always ask for what I need and that that is all I can control.  It's a leap of faith no matter what.  I think it is just that continuing to find space to feel allowed to do either one and continuing to notice what I need and not being afraid to ask for it or lean into what it brings emotionally is a big part of that journey.

00:16:54 Dr. Ruta

I couldn't say it better, we are so appreciative of your time and you're willing to talk to us about these things.  Thank you, thank you, thank you for having me. I appreciate your time.  

00:17:05 Allie

Thank you so much for sharing your experiences, Kara.  I'm sad I couldn't join you in Ruta live.  All four kids had fevers right before we were supposed to fly, and I had to delay a trip home.  But I'm excited to be here today to speak to my own decisions following difficult deliveries.  Hi, Dr. Ruta.  I'm sad I couldn't join you in Kara live, but I'm so excited to be here today.  I was able to listen to the conversation, and I really relate to so much of what Kara experienced.

00:17:33 Dr. Ruta

As we were having the discussions, one of the questions that I was thinking of is just from a family planning perspective, I was just thinking, had something bad happened, how I would go about getting back on the horse again and what has to be aligned before diving back into the pool again?

00:17:54 Allie

I think for me, so my first birth, I do consider traumatic.  My son was born when we were on vacation.  I just showed up at an OB that was friends with my father-in-law and I was not expecting to be admitted.  And I was admitted and then I was in the hospital for a week on bed rest and then had the baby in the NICU for almost a month while we were figuring everything out and we were out of state.  And it just was really chaotic and just all the fear and anxiety that comes with things not going according to plan.  I really felt like I had this planned perfectly.  I was supposed to finish law school and then, a month and a half later, my first child would be born and everything was going to be perfect.  And then my son came two weeks before I graduated law school.  But I think now, looking at it, you can't control everything.  And I think I really pushed ahead in what my plan was.  And I think there's just pros and cons to any choice.  And I feel like I didn't have a lot of self-reflection in that choice.  I just liked my plan and liked having a plan.  But listening to Kara, I loved hearing her thought process and all of the ways that she's evaluating this decision.  Because I really feel, you know, if she decides to move forward with having a second baby or whatever that timing is, she'll really know that she's considered it from all angles.  And of course, you know, it's never going to be perfect or easy, but I think that process of really thinking through and considering all options is really important for the mom and the partner.

00:19:33 Dr. Ruta

That's a really good point.  I think sometimes with traumatic episodes, we can kind of push them aside and not think about them because they're so traumatic.  And I think actually thinking about it, addressing it.  Thinking what can I control, what can I not control is a really important process of sorts for moving forward.  I think I've said this before, but I'll repeat it again, which is that every woman should look for an obstetric provider that is patient, nonjudgmental, that welcomes your questions, that takes time to answer those questions.  And I think you might not get those on the first try.

00:20:19 Allie

Yeah, I love that because it never even occurred to me to meet with different OBs.  Someone I knew had recommended this certain OB that I ended up moving on from.  And, you know, she had great ratings.  She was at a great hospital.  I felt like I was the problem.  You know, I was the one that wasn't making it work.  When you're right, it's just not a good fit all the time.  And that's okay.

00:20:42 Dr. Ruta

Yeah.  We don't really have a sort of tradition of interviewing multiple obstetricians to find the one that's correct for you.  Whereas, you know, if we're looking for a contractor to add an addition to our home, we'll talk to two or three.  But here we are growing our family, having a baby, doing the most important things in our lives.  Often just go to one provider that has a lot of good ratings or that our friend has gone to or that is the best one at the hospital.  And it might not be a great match for you, but it feels very difficult to say, you know, hey, this isn't really working out for me.  I'm going to go interview another obstetric provider.  And it is really hard.  And I am from the medical world.  Have the same feelings, like I'm not being a good patient, I'm not explaining things well enough, or I did something wrong, or I irritated this person in some way.  So it happens to all of us, is what I'm trying to say.

00:21:42 Allie

That's reassuring.  As someone who's not medical, to hear that even someone who is medical can feel that way.  As we wrap up this episode, remember that trauma during pregnancy and the postpartum period are common, and many women will have to make difficult decisions regarding treatment, recovery, and whether to continue to grow their families.  Trauma is often multilayered, and it's important to utilize peer support, therapy, and medication as needed to process all those layers.  Everyone deserves patient, nonjudgmental providers to guide them through pregnancy and beyond.  Give yourself the grace and space to make the decisions that feel best for you.

00:22:22 Dr. Ruta

Thanks for tuning in.  As a reminder, please note that this podcast is not intended to be a substitute for professional medical care.  The views, thoughts, and opinions shared today are the speaker's own.  Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

00:22:49 Allie

This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J.  Willard and Alice S.  Marriott Foundation.  Additional resources are available at Dr. Ruta's resource hub at womensmentalhealth.org.  Listen and subscribe wherever you get your podcasts.